The details of the care will be indicated by the individual doctor, but the general, underlying principles—cleanliness, watchfulness, adaptability and sympathetic understanding will apply to the nursing of all patients. The most notable differences of opinion relate to the care of the breasts, the perineum and the use of abdominal binders, the accepted routine for the general nursing of average, normal cases being fairly uniform the country over.
NURSING CARE
As has been stated, the general nursing care of the puerperal patient is much the same as that given to any surgical patient, with such adaptations as are indicated by the condition and needs of the young mother.
Position in Bed. The question of the patient’s position in bed is probably the first one that presents itself to the nurse after that first hour when the patient must be kept flat on her back and the fundus closely watched. She should continue to lie quietly on her back for a few hours, with only a small pillow under her head, as moving about may cause hemorrhage. Some doctors permit the patient to turn from side to side at will after a few hours of quiet, while others do not allow this for two or three days particularly if the patient has perineal stitches, unless her knees are tightly bound together. Their reason for this precaution is fear that the stitches may be torn out if the thighs are separated and also that air may gain access to the uterine vessels, through the relaxed and gaping birth canal, and produce air embolism. It is a routine in some hospitals to keep the head of the patient’s bed elevated during the first week, to promote drainage, but as a rule it is in the usual position.
Fig. 116.—Height of fundus on each of the first ten days after delivery.
Quite commonly the patient is encouraged to lie first on one side and then on the other, after she begins to move about in bed unassisted, and then face downward at intervals, in order to change the position of the uterus and thus tend to prevent backward displacement.
In many hospitals, it is part of the daily routine to measure and record the height of the fundus (Fig. [116]) above the symphysis, in addition to noting the character, amount and odor of the lochia, in order to judge if involution is progressing normally. A uterus that does not remain firm and does not steadily shrink in size and descend into the pelvis is not involuting properly, and the usual remedy is more rest and a longer stay in bed, with an icecap over the fundus.
Sitting Up. Except when there are perineal stitches or the temperature has been elevated at some time following delivery, the patient is ordinarily allowed to sit up in bed about the sixth or eighth day. If the lochia is normal, the uterus firm and in the proper position in the abdomen and her general condition satisfactory, she is allowed to sit up in a chair for a little while about the ninth or tenth day. Some patients are able to sit up for an hour the first time without being tired, but it is often better for them to sit up for a few moments morning and afternoon on the first day, than for a longer time at one stretch. The patient is usually allowed to sit up an hour longer on each successive day and to walk a few steps on the third or fourth day after getting up.
A patient with stitches does not usually sit up in bed until the ninth or tenth day, when the stitches are removed, sitting up in a chair for an hour, two or three days later. If she has had fever, the time at which she may sit up will of necessity depend upon her condition.